Trigger Point Dry Needling…What Is It Actually Doing?

Trigger point dry needling (TDN) is quickly becoming a reliable, fast and effective way for physical therapists to treat pain and dysfunctions in muscles, however, most people are unfamiliar of the uses and effects of this technique. Many of our clients are interested in knowing the reasons TDN is used, the science behind it and the impact it will have on their body. This blog will help you better understand why the therapists at our clinic utilize TDN in addition to other hands on techniques and exercises to help restore function, aide in recovery and get you back to crushing your goals as quickly and effectively as possible.

By far the most commonly asked question after we recommend TDN is “What is that?” The definition developed by the Federation of State Boards of Physical Therapy is as follows: Dry needling is a skilled technique performed by a physical therapist using filiform needles to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability. (FOSBPT 2015) But what does all of that mean for you?

1.Let’s start with the needles themselves. The filament needles are much smaller than a hypodermic needle that most people are used to seeing at the doctor’s office. They are solid instead of hollow and they are “dry”, meaning they are not used to deliver medication or other injectable substances.

How is it different from acupuncture? The only similarity between the two is the solid filament needle used as the tool for application. The differences are numerous and will be laid out by the focus of the evaluation and by the goals of the treatment. Acupuncture is based on traditional Chinese medicine where an acupuncturist evaluates a patient based on their tongue characteristics and pulse. After this evaluation the acupuncturist uses the information gathered and places the needles in specific points along meridians of the body where the qi (pronounced Chee) flows. The ultimate goal in acupuncture is to restore normal flow of the life forces. This differs immensely from the evaluation and goals of a physical therapist using TDN. The physical therapist will evaluate an entire background/history of an injury based on a client’s report and then perform a hands-on assessment of range of motion, strength, joint mobility, movement patterns, bony alignment, tissue quality, muscle function, posture, and symmetry (just to name a few!). With the information gathered from this assessment, a physical therapist will determine the appropriateness for TDN treatment and which muscles will be most positively affected by the technique. The ultimate goal for the physical therapist’s treatment is to restore function.

We will define a trigger point. A trigger point is a hyperirritable spot in a taut band of skeletal muscle that produces local pain, referred pain, and/or dysfunction when touched. You can feel these spots in your own muscles when you push down or rub back and forth and feel a knot or ropey areas that are also tender. It is important to understand that these trigger points are not the root of the problem. Instead they are a product of the body’s response to a neurological stimulus like underlying weakness, postural deficits, trauma, injury, etc. We treat these trigger points to allow for return of normal muscle function. It is important to understand that treatment won’t stop there and the underlying cause will also need to be addressed.

So why is a trigger point problematic? Research has shown that in the presence of a trigger point biochemical changes will occur in a muscle that causes pain and dysfunction. Some of these changes include an increase in hydrogen ions making the muscle more acidic and decreasing the amount of oxygen available, which causes a decrease in the pain threshold and increased banding in the muscle. They also include an increase in neurotransmitters and neuropeptides that heighten sensitivity to pain and cause the release of inflammatory components. Additionally a trigger point will cause an increase in cytokines and chemokines that results in more sensitive pain receptors leading to pain sensations in the muscles. The science part may be a little boring, but the take-home message is that a dysfunction that leads to trigger point formation will negatively affect the health of your muscles and lead to pain.

Let’s answer the question of what TDN does to positively affect your muscles and lead to restoration of function? To make this part a little less boring we will hit the high points with less science jargon. The physiological changes that occur in the body during and following TDN treatment are: increased blood flow to the muscle in the area of treatment, decreased banding with restoration of a normal length tension relationship (which allows for more efficient contraction), production of a local twitch response that causes a decrease in all of the harmful ions and chemicals mentioned above, decreased spontaneous electrical activity that is correlated with lower pain threshold levels and central nervous system changes that produces systemic effects in the body downstream in muscles that were not needled but that are associated with the targeted muscles.

Now that the science and technique has been described, the last question to answer is how does this impact you on a larger scale? The immediate effects in the clinic that you may notice following a TDN session are increased range of motion, decreased pain, improved fluidity of movement, increased contraction potential of a muscle (strength) and decreased tightness/restriction. However, the most important effect of TDN overall is the restored function of a muscle or a joint. The main goal is to get you back to your favorite exercise, activity or sport without limitations or dysfunctions. If that sounds like something you have been waiting for, but you can’t seem to figure out a way to make it happen, then TDN might just be the right treatment for you. If you are interested in this treatment or have more questions, please feel free to contact a Mobility Fit physical therapist to address all your needs.